T1-weighted Brain Research Articles

Greater cerebellar gray matter volume in car drivers: an exploratory voxel-based morphometry study

Previous functional neuroimaging studies have identified multiple brain areas associated with distinct aspects of car driving in simulated traffic environments. Few studies, however, have examined brain morphology associated with everyday car-driving experience in real traffic. Thus, the aim of the current study was to identify gray matter volume differences between drivers and non-drivers. We collected T1-weighted structural brain images from 73 healthy young adults (36 drivers and 37 non-drivers). We performed a whole-brain voxel-based morphometry analysis to examine between-group differences in regional gray matter volume. Compared with non-drivers, drivers showed significantly greater gray matter volume in the left cerebellar hemisphere, which has been associated with cognitive rather than motor functioning. In contrast, we found no brain areas with significantly greater gray matter volume in non-drivers compared with drivers. Our findings indicate that experience with everyday car driving in real traffic is associated with greater gray matter volume in the left cerebellar hemisphere. This brain area may be involved in abilities that are critical for driving a car, but are not commonly or frequently used during other daily activities.

CUDA-based acceleration and BPN-assisted automation of bilateral filtering for brain MR image restoration.

Bilateral filters have been substantially exploited in numerous magnetic resonance (MR) image restoration applications for decades. Due to the deficiency of theoretical basis on the filter parameter setting, empirical manipulation with fixed values and noise variance-related adjustments has generally been employed. The outcome of these strategies is usually sensitive to the variation of the brain structures and not all the three parameter values are optimal. This article is in an attempt to investigate the optimal setting of the bilateral filter, from which an accelerated and automated restoration framework is developed. To reduce the computational burden of the bilateral filter, parallel computing with the graphics processing unit (GPU) architecture is first introduced. The NVIDIA Tesla K40c GPU with the compute unified device architecture (CUDA) functionality is specifically utilized to emphasize thread usages and memory resources. To correlate the filter parameters with image characteristics for automation, optimal image texture features are subsequently acquired based on the sequential forward floating selection (SFFS) scheme. Subsequently, the selected features are introduced into the back propagation network (BPN) model for filter parameter estimation. Finally, the k-fold cross validation method is adopted to evaluate the accuracy of the proposed filter parameter prediction framework. A wide variety of T1-weighted brain MR images with various scenarios of noise levels and anatomic structures were utilized to train and validate this new parameter decision system with CUDA-based bilateral filtering. For a common brain MR image volume of 256×256×256 pixels, the speed-up gain reached 284. Six optimal texture features were acquired and associated with the BPN to establish a "high accuracy" parameter prediction system, which achieved a mean absolute percentage error (MAPE) of 5.6%. Automatic restoration results on 2460 brain MR images received an average relative error in terms of peak signal-to-noise ratio (PSNR) less than 0.1%. In comparison with many state-of-the-art filters, the proposed automation framework with CUDA-based bilateral filtering provided more favorable results both quantitatively and qualitatively. Possessing unique characteristics and demonstrating exceptional performances, the proposed CUDA-based bilateral filter adequately removed random noise in multifarious brain MR images for further study in neurosciences and radiological sciences. It requires no prior knowledge of the noise variance and automatically restores MR images while preserving fine details. The strategy of exploiting the CUDA to accelerate the computation and incorporating texture features into the BPN to completely automate the bilateral filtering process is achievable and validated, from which the best performance is reached.

Texture based feature extraction method for classification of brain tumor MRI

In machine learning based disease diagnosis, extraction of relevant and informative features from medical image slices is vital aspect. Extracted features represent the descriptive nature of the imaging modality for machine learning. Texture description, is one such method which is used to extract the informative aspect of the object. In this paper a new texture based feature extraction algorithm is proposed for extracting relevant and informative features from brain MR Images having tumor. Suggested algorithm is based on finding the texture description using nine different variants of texture objects. Subsequently, the intermediate texture index matrix is formed using texture objects with high pass and low pass spiral filters. The resultant two index matrix are used to generate the Texture Co-occurrence Matrix (TOM). TOM helps to extract the spatial and spectral domain features that forms the hybrid feature set for brain MRI classification. Using TOM, an experimentation is performed with a dataset of 660 T1-weighted post contrast brain MR Images having 5 different types of malignant tumors. Experimental results suggest that proposed method gives significant results in abnormality classification when compared with state-of-art GLCM and Run length algorithms.

Positive symptoms associate with cortical thinning in the superior temporal gyrus via the ENIGMA Schizophrenia consortium.

Based on the role of the superior temporal gyrus (STG) in auditory processing, language comprehension and self-monitoring, this study aimed to investigate the relationship between STG cortical thickness and positive symptom severity in schizophrenia. This prospective meta-analysis includes data from 1987 individuals with schizophrenia collected at seventeen centres around the world that contribute to the ENIGMA Schizophrenia Working Group. STG thickness measures were extracted from T1-weighted brain scans using FreeSurfer. The study performed a meta-analysis of effect sizes across sites generated by a model predicting left or right STG thickness with a positive symptom severity score (harmonized SAPS or PANSS-positive scores), while controlling for age, sex and site. Secondary models investigated relationships between antipsychotic medication, duration of illness, overall illness severity, handedness and STG thickness. Positive symptom severity was negatively related to STG thickness in both hemispheres (left: βstd = -0.052; P = 0.021; right: βstd = -0.073; P = 0.001) when statistically controlling for age, sex and site. This effect remained stable in models including duration of illness, antipsychotic medication or handedness. Our findings further underline the important role of the STG in hallmark symptoms in schizophrenia. These findings can assist in advancing insight into symptom-relevant pathophysiological mechanisms in schizophrenia.

Functional neuroanatomical associations of working memory in early-onset Alzheimer's disease.

To characterize metabolic correlates of working memory impairment in clinically defined subtypes of early-onset Alzheimer's disease. Established models of working memory suggest a key role for frontal lobe function, yet the association in Alzheimer's disease between working memory impairment and visuospatial and language symptoms suggests that temporoparietal neocortical dysfunction may be responsible. Twenty-four patients with predominantly early-onset Alzheimer's disease were clinically classified into groups with predominantly amnestic, multidomain or visual deficits. Patients underwent neuropsychological evaluation focused on the domains of episodic and working memory, T1-weighted magnetic resonance imaging and brain fluorodeoxyglucose positron emission tomography. Fluorodeoxyglucose positron emission tomography data were analysed by using a region-of-interest approach. Patients with multidomain and visual presentations performed more poorly on tests of working memory compared with amnestic Alzheimer's disease. Working memory performance correlated with glucose metabolism in left-sided temporoparietal, but not frontal neocortex. Carriers of the apolipoprotein E4 gene showed poorer episodic memory and better working memory performance compared with noncarriers. Our findings support the hypothesis that working memory changes in early-onset Alzheimer's disease are related to temporoparietal rather than frontal hypometabolism and show dissociation from episodic memory performance. They further support the concept of subtypes of Alzheimer's disease with distinct cognitive profiles due to prominent neocortical dysfunction early in the disease course. Copyright © 2017 John Wiley & Sons, Ltd.

T1-weighted in vivo human whole brain MRI dataset with an ultrahigh isotropic resolution of 250 \u03bcm

We present an ultrahigh resolution in vivo human brain magnetic resonance imaging (MRI) dataset. It consists of T1-weighted whole brain anatomical data acquired at 7 Tesla with a nominal isotropic resolution of 250 μm of a single young healthy Caucasian subject and was recorded using prospective motion correction. The raw data amounts to approximately 1.2 TB and was acquired in eight hours total scan time. The resolution of this dataset is far beyond any previously published in vivo structural whole brain dataset. Its potential use is to build an in vivo MR brain atlas. Methods for image reconstruction and image restoration can be improved as the raw data is made available. Pre-processing and segmentation procedures can possibly be enhanced for high magnetic field strength and ultrahigh resolution data. Furthermore, potential resolution induced changes in quantitative data analysis can be assessed, e.g., cortical thickness or volumetric measures, as high quality images with an isotropic resolution of 1 and 0.5 mm of the same subject are included in the repository as well.

Closed-form expressions for flip angle variation that maximize total signal in T1-weighted rapid gradient echo MRI.

Magnetization-prepared rapid gradient-echo (MPRAGE) sequences are commonly employed for T1-weighted structural brain imaging. Following a contrast preparation radiofrequency (RF) pulse, the data acquisition proceeds under nonequilibrium conditions of the relaxing longitudinal magnetization. Variation of the flip angle can be used to maximize total available signal. Simulated annealing or greedy algorithms have so far been published to numerically solve this problem, with signal-to-noise ratios optimized for clinical imaging scenarios by adhering to a predefined shape of the signal evolution. We propose an unconstrained optimization of the MPRAGE experiment thatemploys techniques from resource allocation theory. A new dynamic programming solution is introduced that yields closed-form expressions for optimal flip angle variation. Flip angle series are proposed that maximize total transverse magnetization (Mxy) for a range of physiologic T1 values. A 3D MPRAGE sequence is modified to allow for a controlled variation of the excitation angle. Experiments employing a T1 contrast phantom are performed at 3T. 1D acquisitions without phase encoding permit measurement of the temporal development of Mxy. Image mean signal and standard deviation for reference flip angle trains are compared in 2D measurements. Signal profiles at sharp phantom edges are acquired to access image blurring related to nonuniform Mxy development. A novel closed-form expression for flip angle variation is found that constitutes the optimal policy to reach maximum total signal. It numerically equals previously published results of other authors when evaluated under their simplifying assumptions. Longitudinal magnetization (Mz) is exhaustively used without causing abrupt changes in the measured MR signal, which is a prerequisite for artifact free images. Phantom experiments at 3T verify the expected benefit for total accumulated k-space signal when compared with published flip angle series. Describing the MR signal collection in MPRAGE sequences as a Bellman problem is a new concept. By means of recursively solving a series of overlapping subproblems, this leads to an elegant solution for the problem of maximizing total available MR signal in k-space. A closed-form expression for flip angle variation avoids the complexity of numerical optimization and eases access to controlled variation in an attempt to identify potential clinical applications.

Clinical manifestations, neuroimaging features, treatment, and follow-up in four pediatric patients with glutaric aciduria type I

Objective To investigate the clinical features, magnetic resonance imaging(MRI), treatment, and follow-up of patients with glutaric aciduria type Ⅰ (GA-1). Methods Four pediatric patients with GA-1 diagnosed in our hospital were included in this study. They were treated with special diets and carnitine supplements. MRI and tandem mass spectrometry (MS/MS) were performed, and the mental development indices were measured. Results GA-1 was confirmed 2 months, 13 months, 4 months, and 7 months after birth. Seizure had been observed before the disease diagnosis in three patients and disappeared after treatment. In all four patients, T2-weighted brain MRI showed frontotemporal atrophy or hypoplasia and enlarged subarachnoid space in the sylvian fissures and anterior to the temporal lobes. Diffusion weighted imaging revealed high-density lesions over both the putamen and globus pallidus. The patients were followed up for 4 to 5 years. Plasma amino acids and acylcarnitine profile were monitored every 3-5 months. The mean C5DC level and C5DC/C8 were kept the higher limits of the normal ranges, especially in case 3. During the follow-up, the body weight was at -2 SD-0 and the height at -1 SD-0. Intellectual development test showed that case 1 and case 4 had mildly abnormal intelligence, whereas case 2 and case 3 had extremely severe intellectual disability. Gene test confirmed the presence of gene mutations in all four cases, including IVS10 -2A>C homozygous mutation in cases 1, 3, and 4 and [IVS10 -2A>C]+ [c.245G>c(p.Arg82Pro)] hybrid mutation in case 2.Two female children were smoothly enrolled by local kindergarten, while two male children were unable to walk alone due to delayed motor development and spastic paralysis. Conclusions The phenotype of GA-1 patients is not remarkably correlated with its genotype correlation. Newborn screening is essential for identifying GA-1 patients. Key words: Glutaric aciduria type Ⅰ; Magnetic resonance imaging; Follow-up; Intelligence; Treatment

Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis

Neuroimaging studies have shown structural alterations in several brain regions in children and adults with attention deficit hyperactivity disorder (ADHD). Through the formation of the international ENIGMA ADHD Working Group, we aimed to address weaknesses of previous imaging studies and meta-analyses, namely inadequate sample size and methodological heterogeneity. We aimed to investigate whether there are structural differences in children and adults with ADHD compared with those without this diagnosis. In this cross-sectional mega-analysis, we used the data from the international ENIGMA Working Group collaboration, which in the present analysis was frozen at Feb 8, 2015. Individual sites analysed structural T1-weighted MRI brain scans with harmonised protocols of individuals with ADHD compared with those who do not have this diagnosis. Our primary outcome was to assess case-control differences in subcortical structures and intracranial volume through pooling of all individual data from all cohorts in this collaboration. For this analysis, p values were significant at the false discovery rate corrected threshold of p=0·0156. Our sample comprised 1713 participants with ADHD and 1529 controls from 23 sites with a median age of 14 years (range 4-63 years). The volumes of the accumbens (Cohen's d=-0·15), amygdala (d=-0·19), caudate (d=-0·11), hippocampus (d=-0·11), putamen (d=-0·14), and intracranial volume (d=-0·10) were smaller in individuals with ADHD compared with controls in the mega-analysis. There was no difference in volume size in the pallidum (p=0·95) and thalamus (p=0·39) between people with ADHD and controls. Exploratory lifespan modelling suggested a delay of maturation and a delay of degeneration, as effect sizes were highest in most subgroups of children (<15 years) versus adults (>21 years): in the accumbens (Cohen's d=-0·19 vs -0·10), amygdala (d=-0·18 vs -0·14), caudate (d=-0·13 vs -0·07), hippocampus (d=-0·12 vs -0·06), putamen (d=-0·18 vs -0·08), and intracranial volume (d=-0·14 vs 0·01). There was no difference between children and adults for the pallidum (p=0·79) or thalamus (p=0·89). Case-control differences in adults were non-significant (all p>0·03). Psychostimulant medication use (all p>0·15) or symptom scores (all p>0·02) did not influence results, nor did the presence of comorbid psychiatric disorders (all p>0·5). With the largest dataset to date, we add new knowledge about bilateral amygdala, accumbens, and hippocampus reductions in ADHD. We extend the brain maturation delay theory for ADHD to include subcortical structures and refute medication effects on brain volume suggested by earlier meta-analyses. Lifespan analyses suggest that, in the absence of well powered longitudinal studies, the ENIGMA cross-sectional sample across six decades of ages provides a means to generate hypotheses about lifespan trajectories in brain phenotypes. National Institutes of Health.

Sample size requirements for one-year treatment effects using deep gray matter volume from 3T MRI in progressive forms of multiple sclerosis

ABSTRACTObjective: The subcortical deep gray matter (DGM) develops selective, progressive, and clinically relevant atrophy in progressive forms of multiple sclerosis (PMS). This patient population is the target of active neurotherapeutic development, requiring the availability of outcome measures. We tested a fully automated MRI analysis pipeline to assess DGM atrophy in PMS.Design/Methods: Consistent 3D T1-weighted high-resolution 3T brain MRI was obtained over one year in 19 consecutive patients with PMS [15 secondary progressive, 4 primary progressive, 53% women, age (mean±SD) 50.8±8.0 years, Expanded Disability Status Scale (median, range) 5.0, 2.0–6.5)]. DGM segmentation applied the fully automated FSL-FIRST pipeline (http://fsl.fmrib.ox.ac.uk). Total DGM volume was the sum of the caudate, putamen, globus pallidus, and thalamus. On-study change was calculated using a random-effects linear regression model.Results: We detected one-year decreases in raw [mean (95% confidence interval): –0.749 ml (–1.455, –0.043), p = 0.039] and annualized [–0.754 ml/year (–1.492, –0.016), p = 0.046] total DGM volumes. A treatment trial for an intervention that would show a 50% reduction in DGM brain atrophy would require a sample size of 123 patients for a single-arm study (one-year run-in followed by one-year on-treatment). For a two-arm placebo-controlled one-year study, 242 patients would be required per arm. The use of DGM fraction required more patients. The thalamus, putamen, and globus pallidus, showed smaller effect sizes in their on-study changes than the total DGM; however, for the caudate, the effect sizes were somewhat larger.Conclusions: DGM atrophy may prove efficient as a short-term outcome for proof-of-concept neurotherapeutic trials in PMS.

Morphometry analysis of basal ganglia structures in children with obstructive sleepapnea.

Obstructive sleep apnea (OSA) affects both adults and children, likely mediated by the deficits of various brain regions. The association between structural alterations in the brain and OSA syndrome have been reported in adult patients, but the corresponding evidence for OSA children is still limited. The proposed study aimed to investigate the structural alterations in the brain of children with OSA, with focus on basal ganglia structures. We recruited 25 OSA children (aged 10.3±1.5 years) and 30 healthy children (aged 10.1±1.8 years) with T1-weighted brain MRI and performed automatic segmentation of their brains. The shape alterations of the basal ganglia structures for OSA syndrome was determined by comparison of the OSA group and control group with surface-based shape analysis. Differences in the morphometry of the left thalamus and the left pallidum were found between the OSA group and control group. Compared to the control group, the OSA group presented significant atrophy in the ventral posterior nucleus and the medial dorsal nucleus of the left thalamus, while regional dilation was found in both the internal and external segments of the left pallidum. These findings identified the association between the structural deficits of the thalamus and OSA syndrome in children, which was consistent with the existing findings in OSA adults. In addition, the present study provided new insights to the distinctive pattern of structural changes of the pallidum in pediatric OSA when compared to adult OSA.

Cortical Thickness of Native Tibetans in the Qinghai-Tibetan Plateau.

High-altitude environmental factors and genetic variants together could have exerted their effects on the human brain. The present study was designed to investigate the cerebral morphology in high-altitude native Tibetans. T1-weighted brain images were obtained from 77 Tibetan adolescents on the Qinghai-Tibetan Plateau (altitude, 2300-5300 m) and 80 matched Han controls living at sea level. Cortical thickness, curvature, and sulcus were analyzed by using FreeSurfer. Cortical thickness was significantly decreased in the left posterior cingulate cortex, lingual gyrus, superior parietal cortex, precuneus, and rostral middle frontal cortex and the right medial orbitofrontal cortex, lateral occipital cortex, precuneus, and paracentral lobule. Curvature was significantly decreased in the left superior parietal cortex and right superior marginal gyrus; the depth of the sulcus was significantly increased in the left inferior temporal gyrus and significantly decreased in the right superior marginal gyrus, superior temporal gyrus, and insular cortex. Moreover, cortical thickness was negatively correlated with altitude in the left superior and middle temporal gyri, rostral middle frontal cortex, insular cortex, posterior cingulate cortex, precuneus, lingual gyrus, and the right superior temporal gyrus. Curvature was positively correlated with altitude in the left rostral middle frontal cortex, insular cortex, and middle temporal gyrus. The depth of the sulcus was negatively correlated with altitude in the left lingual gyrus and right medial orbitofrontal cortex. Differences in cortical morphometry in native Tibetans may reflect adaptations related to high altitude.

Multi-contrast brain magnetic resonance image super-resolution using the local weight similarity

BackgroundLow-resolution images may be acquired in magnetic resonance imaging (MRI) due to limited data acquisition time or other physical constraints, and their resolutions can be improved with super-resolution methods. Since MRI can offer images of an object with different contrasts, e.g., T1-weighted or T2-weighted, the shared information between inter-contrast images can be used to benefit super-resolution.MethodsIn this study, an MRI image super-resolution approach to enhance in-plane resolution is proposed by exploring the statistical information estimated from another contrast MRI image that shares similar anatomical structures. We assume some edge structures are shown both in T1-weighted and T2-weighted MRI brain images acquired of the same subject, and the proposed approach aims to recover such kind of structures to generate a high-resolution image from its low-resolution counterpart.ResultsThe statistical information produces a local weight of image that are found to be nearly invariant to the image contrast and thus this weight can be used to transfer the shared information from one contrast to another. We analyze this property with comprehensive mathematics as well as numerical experiments.ConclusionExperimental results demonstrate that the image quality of low-resolution images can be remarkably improved with the proposed method if this weight is borrowed from a high resolution image with another contrast.Graphical Multi-contrast MRI Image Super-resolution with Contrast-invariant Regression Weights

Assessment of Early Evidence of Multiple Sclerosis in a Prospective Study of Asymptomatic High-Risk Family Members

Subclinical inflammatory demyelination and neurodegeneration often precede symptom onset in multiple sclerosis (MS). To investigate the prevalence of brain magnetic resonance imaging (MRI) and subclinical abnormalities among asymptomatic individuals at risk for MS. The Genes and Environment in Multiple Sclerosis (GEMS) project is a prospective cohort study of first-degree relatives of people with MS. Each participant's risk for MS was assessed using a weighted score (Genetic and Environmental Risk Score for Multiple Sclerosis Susceptibility [GERSMS]) comprising an individual's genetic burden and environmental exposures. The study dates were August 2012 to July 2015. Participants in the top and bottom 10% of the risk distribution underwent standard and quantitative neurological examination, including disability status, visual, cognitive, motor, and sensory testing, as well as qualitative and quantitative neuroimaging with 3-T brain MRI and optical coherence tomography. This study included 100 participants at risk for MS, with 41 at higher risk (40 women [98%]) and 59 at lower risk (25 women [42%]), at a mean (SD) age of 35.1 (8.7) years. Given the unequal sex distribution between the 2 groups, the analyses were restricted to women (n = 65). When considering all measured outcomes, higher-risk women differed from lower-risk women (P = .01 by omnibus test). Detailed testing with a vibration sensitivity testing device in a subgroup of 47 women showed that higher-risk women exhibited significantly poorer vibration perception in the distal lower extremities (P = .008, adjusting for age, height, and testing date). Furthermore, 5 of 65 women (8%) (4 at higher risk and 1 at lower risk) met the primary neuroimaging outcome of having T2-weighted hyperintense brain lesions consistent with the 2010 McDonald MRI criteria for dissemination in space. A subset of participants harbor many different neuroimaging features associated with MS, including perivenous T2-weighted hyperintense lesions and focal leptomeningeal enhancement, consistent with the hypothesis that these individuals are at higher risk of developing clinical symptoms of MS than the general population. Higher-risk asymptomatic family members of patients with MS are more likely to have early subclinical manifestations of MS. These findings underscore the importance of early detection in high-risk individuals. clinicaltrials.gov Identifier: NCT01353547.

Objectively measured sedentary behavior and brain volumetric measurements in multiple sclerosis.

This study examined the association between sedentary behavior patterns and whole brain gray matter (GM), white matter (WM) and subcortical GM structures in persons with multiple sclerosis (MS). 36 persons with MS wore an accelerometer and underwent a brain MRI. Whole brain GM and WM and deep GM structures were calculated from 3D T1-weighted structural brain images. There were statistically significant (p < 0.01) and moderate or large associations between number of sedentary bouts/day and brain volume measures. The primary result was a consistent negative association between number of sedentary bouts/day and whole brain GM and WM, and deep GM structures. We provide novel evidence for decreased brain volume as a correlate of a sedentary behavior pattern in persons with MS.

Factors predicting response to the first epidural blood patch in spontaneous intracranial hypotension.

Spontaneous intracranial hypotension results from cerebrospinal fluid leakage. Currently, the treatment of choice for spontaneous intracranial hypotension is the epidural blood patch, which has a variable response rate and no clear outcome predictors. This study aimed to identify predictors for response rate of a first targeted epidural blood patch in patients with spontaneous intracranial hypotension. We reviewed cases of patients with spontaneous intracranial hypotension who received targeted epidural blood patch at our hospital between 1 January 2007 and 1 July 2014. The outcome measure was first epidural blood patch response. We analysed demographics, clinical manifestations, neuroimaging findings (non-contrast heavily T2-weighted magnetic resonance myelography and brain magnetic resonance imaging), and blood volume as potential outcome predictors. Significant predictors were tested and a decision tree was used to construct a predictive model. In total, 150 patients with spontaneous intracranial hypotension were included for final analyses. Their overall first targeted epidural blood patch response rate was 58.7%. Among patients with a greater injected blood volume (≥22.5 versus <22.5 ml), the response rate was higher (67.9% versus 47.0%, P = 0.01). In brain and spinal magnetic resonance imaging studies, significant predictors included anterior epidural cerebrospinal fluid collection length (<8 versus ≥8 segments; 72.5% versus 37.3%, odds ratio = 4.4, 95% confidence interval: 2.2-8.9, P < 0.001) and midbrain-pons angle (≥40° versus <40°; 71.3% versus 37.5%, odds ratio = 4.1, 95% confidence interval 2.1-8.3, P < 0.001). Decision tree analyses showed that patients with anterior epidural CSF collection involving <8 segments and an injected blood volume ≥22.5 ml had an 80.0% response rate. Patients with anterior epidural cerebrospinal fluid collection involving ≥8 segments and a midbrain-pons angle <40° had a 21.2% response rate. These three variables predicted first epidural blood patch response in 71.3% of patients. Brain and spinal neuroimaging findings and epidural blood patch blood volume can be used to predict targeted first epidural blood patch response in patients with spontaneous intracranial hypotension.

Correlation between hippocampal volumes and medial temporal lobe atrophy in patients with Alzheimer's disease.

Introduction:Hippocampus undergoes atrophy in patients with Alzheimer's disease (AD). Calculation of hippocampal volumes can be done by a variety of methods using T1-weighted images of magnetic resonance imaging (MRI) of the brain. Medial temporal lobes atrophy (MTL) can be rated visually using T1-weighted MRI brain images. The present study was done to see if any correlation existed between hippocampal volumes and visual rating scores of the MTL using Scheltens Visual Rating Method.Materials and Methods:We screened 84 subjects presented to the Department of Neurology of a Tertiary Care Hospital and enrolled forty subjects meeting the National Institute of Neurological and Communicative Disorders and Stroke, AD related Disease Association criteria. Selected patients underwent MRI brain and T1-weighted images in a plane perpendicular to long axis of hippocampus were obtained. Hippocampal volumes were calculated manually using a standard protocol. The calculated hippocampal volumes were correlated with Scheltens Visual Rating Method for Rating MTL. A total of 32 cognitively normal age-matched subjects were selected to see the same correlation in the healthy subjects as well. Sensitivity and specificity of both methods was calculated and compared.Results:There was an insignificant correlation between the hippocampal volumes and MTL rating scores in cognitively normal elderly (n = 32; Pearson Correlation coefficient = 0.16, P > 0.05). In the AD Group, there was a moderately strong correlation between measured hippocampal volumes and MTL Rating (Pearson's correlation coefficient = −0.54; P < 0.05. There was a moderately strong correlation between hippocampal volume and Mini-Mental Status Examination in the AD group. Manual delineation was superior compared to the visual method (P < 0.05).Conclusions:Good correlation was present between manual hippocampal volume measurements and MTL scores. Sensitivity and specificity of manual measurement of hippocampus was higher compared to visual rating scores for MTL in patients with AD.

Atypical Structural Asymmetry of the Planum Temporale is Related to Family History of Dyslexia.

Research on the neural correlates of developmental dyslexia indicates atypical anatomical lateralization of the planum temporale, a higher-order cortical auditory region. Yet whether this atypical lateralization precedes reading acquisition and is related to a familial risk for dyslexia is not currently known. In this study, we address these questions in 2 separate cohorts of young children and adolescents with and without a familial risk for dyslexia. Planum temporale surface area was manually labeled bilaterally, on the T1-weighted MR brain images of 54 pre-readers (mean age: 6.2 years, SD: 3.2 months; 33 males) and 28 adolescents (mean age: 14.7 years, SD: 3.3 months; 11 males). Half of the pre-readers and adolescents had a familial risk for dyslexia. In both pre-readers and adolescents, group comparisons of left and right planum temporale surface area showed a significant interaction between hemisphere and family history of dyslexia, with participants who had no family risk for dyslexia showing greater leftward asymmetry of the planum temporale. This effect was confirmed when analyses were restricted to normal reading participants. Altered planum temporale asymmetry thus seems to be related to family history of dyslexia.

Revisiting the Pharmacokinetic Profiles of Gadolinium-Based Contrast Agents

Gadolinium-based contrast agents (GBCAs) have been used for years for magnetic resonance imaging examinations. Because of their rapid blood clearance, they were considered as very safe products until some of them were shown to induce nephrogenic systemic fibrosis in patients with renal failure and hypersignals on T1-weighted unenhanced brain scans of patients with normal renal function. To date, these adverse effects have been related almost exclusively to the use of low-stability linear agents, which are more prone to release free gadolinium. The aim of the present meta-analysis was to ascertain the existence of a deep compartment for gadolinium storage in the body and to assess whether all the GBCAs present the same toxicokinetic profile. Applying a systematic literature search methodology, all clinical and preclinical studies reporting time-dependent plasma concentrations and renal excretion data of gadolinium were identified and analyzed. Since the individual data were not available, the analysis focused on the average values per groups of subjects or animals, which had received a given GBCA at a given dose. The rate constants of the distribution phase (α), rapid elimination phase (β), and residual excretion phase (γ) of gadolinium were determined in each group from the plasma concentration (Cp) time curves and the relative urinary excretion rate (rER) time curves, taking the 2-hour time point as a reference. Moreover, as bone may represent a reservoir for long-term gadolinium accumulation and slow release into the blood stream, the time curves of the relative concentration in the bone (rCB) of Gd-labeled GBCAs in mice or rats were analyzed taking day 1 concentrations as a reference. The ratio of gadolinium concentrations in the bone marrow (CBM) as compared with the bone (CB) was also calculated. The relative urinary excretion rate (rER) plots revealed a prolonged residual excretion phase of gadolinium in healthy volunteers, consistent with the existence of a deep compartment of distribution for the GBCAs. The rate constant γ of gadoterate meglumine (0.107 hour) is 5 times higher than that of the linear agents (0.020 ± 0.008 hour), indicating a much faster blood clearance for the macrocyclic GBCA. Similar results were obtained in the preclinical studies. A strong correlation was shown between the γ values of the different products and their respective thermodynamic stability constants (Ktherm). Greater clearance rates of Gd from murine bone were also found after gadoterate meglumine or gadoteridol injection (0.131-0.184 day) than after administration of the linear agents (0.004-0.067 day). The concentrations of Gd in the bone marrow (CBM) from animals exposed to either gadoterate meglumine or gadodiamide are higher than those in the bone (CB) for at least 24 hours. Moreover, the ratio of concentrations (CBM/CB) at 4 hours is significantly lower with the former agent than the latter (1.9 vs 6.5, respectively). Using a nonconventional pharmacokinetic approach, we showed that gadoterate meglumine undergoes a much faster residual excretion from the body than the linear GBCAs, a process that seems related to the thermodynamic stability of the different chelates. Gadolinium dissociation occurs in vivo for some linear chelates, a mechanism that may explain their long-term retention and slow release from bone. Potential consequences in terms of bone toxicity warrant further investigations.

Effect of Renal Function on Gadolinium-Related Signal Increases on Unenhanced T1-Weighted Brain Magnetic Resonance Imaging.

The purpose of this study was to determine if renal function affects signal changes in the deep brain nuclei on unenhanced T1-weighted images after administration of linear gadolinium-based contrast agents (GBCAs). An electronic medical records search of 2 large medical centers identified 25 patients who received linear GBCA while on hemodialysis and had unenhanced T1-weighted images of the brain before and after. The dentate-to-cerebellar peduncle (DCP) ratio, globus pallidus-to-mid thalamus (GPT) ratio, and choroid plexus-to-nearby white matter ratio were measured and compared with 25 age/sex/GBCA exposure-matched control patients with normal or near-normal renal function (estimated glomerular filtration rate >60 mL/min per 1.73 m). Two additional control groups included 13 patients on hemodialysis without GBCA exposure and 13 age/sex-matched patients with estimated glomerular filtration rate greater than 60 mL/min per 1.73 m. Hemodialysis patients (n = 25) with an average of 1.8 linear GBCA administrations had a 4.9% mean increase (1.00 ± 0.04 vs 1.05 ± 0.05; P < 0.001) in DCP, which was greater than the 1.6% change (0.99 ± 0.04 vs 1.00 ± 0.05; P = 0.08) observed in matched controls (P = 0.01). There was no significant signal change in the DCP ratio in the 13 hemodialysis patients (0.99 ± 0.04 vs 0.99 ± 0.04; P = 0.78) and 13 age/sex-matched patients (0.99 ± 0.02 vs 0.99 ± 0.03; P = 0.78) who did not receive GBCA. The hemodialysis patients had a baseline GPT that was higher than nondialysis patients (P < 0.001). However, the GPT change after GBCA administration was not significantly different from controls. Increased signal in the choroid plexus on unenhanced T1-weighted images after GBCA administration was noted in hemodialysis patients (0.72 ± 0.20 vs 0.86 ± 0.23; P = 0.006); however, a multivariate analysis showed this to be primarily related to hemodialysis (P = 0.003) with only a trend toward relating to GBCA exposure (P = 0.07). Hemodialysis patients receiving linear GBCA have greater dentate nucleus signal increases on unenhanced T1-weighted images, suggesting that renal function may affect the rate of gadolinium accumulation in the brain after linear GBCA-enhanced magnetic resonance imaging.